Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery

Scharpf, Danielle; Sharma, Mayur; Deogaonkar, Milind; Rezai, Ali R.; Bergese, Sergio D.

doi:10.4097/kjae.2015.68.4.332

Cited by 5 publications

(3 citation statements)

References 65 publications

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“…The recommendation is to control the systolic blood pressure below 140 mmHg or within 20% of the patient's baseline systolic blood pressure. [ 5 20 26 ] No detection of venous air embolism (VAE) in our study can be attributed to the fact that we defined VAE based on the clinical diagnosis. If the monitorings with high sensitivity for VAE were used, the incidence of VAE should be detected more.…”

Section: Discussionmentioning

confidence: 91%

Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study

Eiamcharoenwit,

Akavipat

2024

Saudi Journal of Anaesthesia

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Background: Various complications occur in patients undergoing deep brain stimulation (DBS) surgery. The objective of this study was to determine the incidence of complications in patients with Parkinson's disease who underwent DBS surgery and identify the risk factors, especially anesthetic factors. Methods: A retrospective cohort study was performed between May 2015 and December 2022. Based on a review of medical charts, patients aged 18 years or older who underwent DBS surgery at a tertiary neurological center in Thailand were recruited. Univariate analysis using the Chi-square test or Fisher's exact test was performed to compare patients with and without complications. Multivariate logistic regression analysis was performed to identify the predictive factors for complications. Results: The study included 46 patients. The most common complication during DBS electrode placement was hypertension (30/46, 65.2%), and 19 patients (41.3%) who developed hypertension did not receive antihypertensive treatment. The most common complication during battery placement was clinical hypotension (14/46, 30.4%). The most common postoperative complication was delirium (6/46, 13.0%). In the multivariate analysis, no significant independent risk factors for overall complications after DBS surgery were identified. Conclusions: Hypertension during DBS electrode insertion was the most common perioperative complication. Hemodynamic instability is preventable and manageable, and vigilant and prompt treatment should be provided during DBS surgery.

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Section: Discussionmentioning

confidence: 91%

Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study

Eiamcharoenwit,

Akavipat

2024

Saudi Journal of Anaesthesia

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“…Patients, therefore, may receive anesthesia care in the form of monitored anesthesia care with local anesthesia, conscious sedation and general anesthesia. 12,13,14 Comparison of anesthesia technique and outcomes with other series is not an objective of this paper and would probably be inappropriate due to the limited experience at present.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management in Bilateral Deep Brain Stimulation for X-linked Dystonia Parkinsonism: Early Single Institution Experience from the Philippines

Chiong-Perez¹,

Diesta²,

Oropilla³

2020

Acta Med Philipp

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X-linked dystonia-parkinsonism (XDP) is a rare, adult-onset, progressive, hereditary neurological movement disorder primarily affecting Filipino men with maternal families from Panay province of the Philippines. Medical treatment modalities currently being used have offered temporary symptomatic relief. Surgical management in the form of bilateral globus pallidi internae (Gpi) deep brain stimulation (DBS) has shown promising results and is increasingly being performed in advanced centers, as reported in international literature. Presented herein is the local experience of seven (7) retrospectively reviewed cases from February 2018 to February 2019 in a tertiary center in the Philippines with a particular focus on anesthetic management. All patients were male, from Panay, and presented with progressive dystonia and parkinsonism. All patients underwent planned bilateral, simultaneous DBS electrode, and implantable pulse generator (IPG) placement performed by a multidisciplinary team. Anesthetic management consisted of Bispectral Index (BIS) guided conscious sedation with low dose propofol and remifentanil infusions with a complete scalp nerve block (SB) at the start of the procedure then shifted to awake monitored anesthesia care during electrode placement, microelectrode recording (MER) and macro stimulation testing. All were put under general anesthesia with a supraglottic airway device during the placement of the internal pulse generator (IPG) in the infraclavicular area. All seven patients had successful localization, and insertion of the DBS electrode and discharged improved. The anesthetic management of the DBS used in these cases warrants further investigation and may lead to standardization of future practice.

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“…As neurosurgeons carefully select patients who might benefit from DBS treatment based on certain medical criteria, anesthesiologists are expected to decide the type of anesthesia in a similar manner [36].…”

Section: Anesthetic Considerations In Patients Undergoing Dbsmentioning

confidence: 99%

Anesthetic Considerations for Deep Brain Stimulation

Fiorda-Diaz¹,

Stoicea²,

Deogaonkar³

et al. 2016

From Bench to Bedside - Trauma, Tumors, Spine, Functional Neurosurgery

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Deep brain stimulation (DBS) was used to treat refractory Parkinson's disease (PD) for the first time in 1987 by Professor Benabid's group by placing stimulating electrodes into targeted brain structures. DBS is a widely accepted neurosurgical treatment for Parkinson's disease (PD), benign tremor, dystonia, epilepsy, and other neuropsychiatric disorders with no significant changes in anatomical brain structures. Prior to the introduction of DBS, traditional treatment for PD involved surgical removal of parts of the brain known as thalamotomy, pallidotomy, and cingulotomy. Intraoperative identification of the affected areas of brain is possible through a couple of mechanisms involving electrical stimulation and monitoring of the brain function, known as "functional neurosurgery". Implantation of electrodes in the targeted area and the insertion of a programmable pulse generator under the clavicle or in the abdomen are the main steps in DBS surgery. Anesthetic management for DBS remains controversial and might vary between institutions and physicians. Although no guidelines have been developed, there are some common anesthetic considerations for DBS surgery, including difficult airway management, facilitation of neuromonitoring, and anesthetic drugs interference with microelectrode recordings (MERs). Local anesthesia, general anesthesia, and monitored anesthesia care (MAC) have been used worldwide in patients undergoing DBS.

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Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery

Cited by 5 publications

References 65 publications

Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study

Incidence of complications associated with deep brain stimulation surgery in patients with Parkinson's disease: An 8-year retrospective study

Anesthetic Management in Bilateral Deep Brain Stimulation for X-linked Dystonia Parkinsonism: Early Single Institution Experience from the Philippines

Anesthetic Considerations for Deep Brain Stimulation

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